The Dr. Hyman Show - Which Supplements Are Most Beneficial?

Episode Date: July 8, 2022

This episode is brought to you by Gut Food, Athletic Greens, and Rupa Health.   We are living in a time unlike any before. For multiple reasons, we are now unable to get optimal amounts of all of the nutrients we need to function the way we were designed to. That’s why we need to turn to certain supplements to combat the nutritional deficiencies—like vitamin D, magnesium, omega 3 fatty acids, and more—the majority of us are faced with.    In today’s episode, I talk with Dhru Purohit, Dr. Elizabeth Boham, and Dr. James DiNicolantonio about why our modern diet and lifestyle are leaving us nutritionally deficient, the benefits of supplementation, and the importance of adequate magnesium levels.   Dhru Purohit is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top 50 global health podcast with over 30 million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset.   Dr. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing.   Dr. DiNicolantonio is a Doctor of Pharmacy and a cardiovascular research scientist. A well-respected and internationally known scientist and an expert on health and nutrition, he has contributed extensively to health policy and has testified in front of the Canadian Senate regarding the harms of added sugars. He serves as the associate editor of the British Medical Journal’s Open Heart, a journal published in partnership with the British Cardiovascular Society, and is on the editorial advisory boards of several other medical journals. Dr. DiNicolantonio is the author or coauthor of over 250 publications in the medical literature. He is also the author of five bestselling health books: The Salt Fix, Superfuel, The Longevity Solution, The Immunity Fix, and The Mineral Fix.   This episode is brought to you by Gut Food, Athletic Greens, and Rupa Health.   Check out Gut Food at gutfood.com.   Right now, when you purchase AG1 from Athletic Greens, you will receive 10 FREE travel packs with your first purchase by visiting athleticgreens.com/hyman.   Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com.   Full-length episodes of these interviews can be found here: Dhru Purohit Dr. Elizabeth Boham Dr. James DiNicolantonio

Coming up on this episode of The Doctor's Pharmacy. People need foundational nutritional support. Everybody should be on a good multivitamin with the right forms of nutrients in the right balance. In my practice, I always look at the gut first. When someone's gut is messed up, it can impact their overall health, their mood, energy levels, skin, digestion,

and everything in between. I always thought I did a pretty good job at taking care of my own gut, but when I got really sick a few years ago from mold poisoning, a root canal gone wrong, an antibiotic, and a few other insults, I realized that I had a lot of gut healing to do. I talked to S-Burson Gut Health, read a ton of new research on the microbiome, and figured out a way to heal my body using three critical things, prebiotics, probiotics, and polyphenols. I created a multivitamin for the

gut and you can't keep that information yourself. So I put it all together into a simple daily product that anyone can take and it's called Gut Food. This product uses five powerful ingredients at clinically validated dosages to help reduce inflammation, support the growth of beneficial gut bacteria, improve digestion and bloating, and support mood and energy. I really believe this is the next frontier of gut health. Just like we take a multivitamin and mineral to give our bodies the nutrients we need, our gut also requires specific ingredients to thrive.

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superfoods probiotics and adaptogens to support my entire body even with a really healthy diet is hard to hit the mark for all our nutrient needs so i feel better knowing that i have some extra help from ag1 unlike other supplements and powders out there ag1 is third-party tested and made without gmos nasty nasty chemicals, or artificial anything. And it tastes great, kind of like a tropical green drink. I like it on its own mixed with water, but it also works really well in most smoothies. If you're curious about trying AG1 from Athletic Greens for yourself right now, they're offering my community 10 free travel packs with your first purchase.

All you have to do is visit athleticgreens.com forward slash hyman. Again, that's athleticgreens.com forward slash hyman to take ownership over your health and pick up the ultimate daily nutritional insurance. As a busy doctor with multiple jobs, I'm all about tools that make my life simpler. And since testing is something I rely on to help almost all my patients, I was really excited to learn about Rupa Health. Hormones, organic acids, nutrient levels, inflammatory factors, and gut bacteria are just some of the many things I look at to find the most effective path to optimal health for my patients. But that means I'm placing orders through multiple labs, which is an overall pain, and it also makes keeping track of results more difficult for me and my patients and other

doctors. Rupa Health has totally changed that. They've made functional medicine testing simpler and more convenient than ever so that practitioners like me can focus on helping their patients. With Rupa Health, functional medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like Dutch, Vibrant America, Genova, Great Plains, and more. It's 90% faster, letting you simplify the process of getting the functional tests you need and providing a noticeably better patient experience. This is really a very much needed option in the functional

medicine space that I'm so excited about. You can check out our free live demo and a Q&A or create an account at rupahealth.com. That's R-U-P-A health.com. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Fee and one of the producers of The Doctor's Pharmacy podcast. Vitamins and minerals have an enormous impact on our overall health. However, nutrient deficiencies are pervasive due to factors including soil health, taking medications, our overall gut health, inflammation, and more. And because our government's recommended daily allowance is based on preventing deficiencies rather than optimizing health, a close look at our nutrient status and supplementation is vital. In today's episode,

we feature three conversations from the doctor's pharmacy on how supplements can be beneficial for our overall health. Dr. Hyman speaks with Drew Pruitt on why he recommends supplementation, with Dr. Elizabeth Boehm on nutritional deficiencies and why magnesium is so important, and with Dr. James DiNicolantonio on how drugs impair the body's ability to absorb minerals and much more. Let's dive in. Our food supply has been hybridized to breed out nutrition. It's bred for starch and maybe a little protein, but not for nutrients. It's also grown in soils that have very little organic matter. They can't extract the nutrients from the soil for the plants. So there are nutrients in the soil, but the plants need the microorganism in the soil to actually, as symbiotic helpers, to extract the nutrients

from the soil to go into the plant. So then it's in the plant, then you can eat it. But now maybe your broccoli today is 50% less nutritious than it was 50 years ago. So that's another problem. And then we have increased nutrient needs because we're under chronic stress, because we're exposed to environmental toxins. I mean, there were 80,000 new chemicals introduced into the marketplace since the 1900s. I mean, our bodies have to deal with all that stuff. And there's chemical reactions and detoxification, and they all require nutrients. And we are also under a tremendous amount of psychological stress, even in society. And magnesium, your body wastes magnesium when you're under psychological stress. So there's so many things that are happening in our omega-3

fats. We don't get those because we don't really eat wild food anymore. Maybe some fish, but that's got mercury. So there's all these problems that happen because of our nutritional environment. And so more than ever now, people need foundational nutritional support. I believe that. And I say this not from a sort from a general opinion, but actually from really hard scientific data. And they go, oh, well, all the vitamin studies, they show that they don't prevent heart attacks, they don't prevent cancer, they don't do this, they don't do that, or they may have side effects. And the truth is the studies are just all poorly designed. I mean, it's like, think about Michael Jordan,

like arguably the best basketball player in history. If you put him on a court by himself, he could not win a single game, right? Against another team that had a full team. Yeah, right? So nutrients work as a team. And if you don't have all of them, your biochemistry kind of gets gummed up

and it can actually cause worse problems. So for example, they did this large study called the carrot study where they gave smokers who were at high risk for lung cancer beta carotene because it seemed like people ate fruits and vegetables with lots of beta carotene actually did better. But when they actually gave the beta carotene as a supplement, what happened was there was more cancer. Now in the science was like, oh, this is terrible. Supplements don't work. I was like, oh, this is terrible. Subtlets don't work. I'm like, one, this is a perfect example of what Michael Pollan calls nutritionism,

which is reductionism in nutrients, where you basically see, oh, it's maybe this single thing and we're going to replace that. It doesn't work like that. Which is how they think about drugs. Drugs, right. So basically, the carrot study gave high dose of beta carotene. Now, if you actually understand basic biology and how antioxidants work in the system, they work as a team. So if you give one of them, the way they

work is they donate an electron to some damaged tissue or free radical, like an oxidized compound in the body. So an antioxidant will actually help deal with oxidative stress or rusting in the body, but the way it does it is it donates one of its electrons. Then it becomes a radical. So for example, vitamin C is a great antioxidant, but it'll donate one of its electrons. And then it becomes an ascorbyl radical, which is highly dangerous. But don't worry, then you got vitamin E to help take that electron from vitamin E and give it to the vitamin C. And it becomes a tocopherol radical. And then that has to be dealt with by all these systems like poic acid. And that then has to be dealt with by

glutathione. So you've got a whole system. If you don't have all the antioxidants and you don't have the final pathways of glutathione, you're going to get in trouble. And so you're actually create more oxidative stress and more damage if you just give a high dose of a single nutrient like that. All to say that it's another reason why that even if we have a good idea about a cocktail that would be supplemental, this just is another reminder why the base foundation of your diet is so key because there could be cofactors and coenzymes and other aspects that are all related to this that we can't even begin to understand. So having a really incredible diet, even if you do choose to dabble into

supplements here and there to be a bonus, a supplemental to your diet is such a key reminder. It's key. And so, you know, I believe everybody needs a good multivitamin, fish oil, vitamin D. Let's divide this and let's go through this. Instead of the three, let's divide this into like foundational items that are there. And then let's get into really the topic of today's episode, which is kind of these bonus ones that are really being highlighted for their specific role in longevity. So take us through the supplemental foundational ones. So basically, everybody should be on a good multivitamin with the right forms of nutrients

in the right balance and when i say the right forms and bioavailable because for example you can go to the drugstore and buy magnesium oxide but it's the cheapest form of magnesium but it's poorly absorbed uh and you if or you could buy folic acid but maybe your genetics don't allow you to convert it to the effective form of folic acid called methylfolate. So you need to buy methylfolate. So you don't, it's really important to know what your body needs. But a basic good multivitamin from a company that focuses on therapeutic products that are mostly doctor-related companies, but you can still get these products, that's a good

place to start. Then fish oil, really important. And there's many different kinds of fish oil. There's, you know, you kind of worry about where it comes from. Was it distilled? Does all the, are all the toxins and mercury out of it? Is it oxidized? What's it preserved with?

What kind of animal is it from? Like there's a whole bunch of questions, right? But like there's also ways of processing it that preserve a lot of the benefits of fish oil. Like Big Bull's Health has a product called Dutch Harbor Omega. Just transparently, we're involved with Big Bull Health. It's my mentor, Jeffrey Bland's company. And it's very impressive. He's basically found a process by which they extract the fish oil in Alaska from wild salmon and other fish that preserves something that is really important in fish oil called pro-isolvent

mediators. So you can get EPA, DHA, which is fish oil. But then also what's so amazing about eating fish and fish is that there's these compounds that have been recently discovered that are like the brake on your immune system. So we have an accelerator on our immune system, brake on our immune system. So our immune system, they're so overactive in inflammation. So these pro-isolvent mediators, which have been extensively studied at Harvard, are amazing. And they're contained in this particular fish oil, Dutch Harbor Omega, because it actually processes in a way that doesn't destroy it. The third key supplement is, and by the way, like I said, 90 plus percent of people are deficient in omega-3 fats. So that's just a no-brainer. And there was a big study that came out last year showing that uh uh individuals who were at the right omega index

had an extra uh three to five years of their life yeah no doubt no doubt so if you're talking about longevity even though it's foundational like this is one of those things to really look at these are called essential fatty acids that means they're essential for life they're like a vitamin if you don't have them, you're screwed. And every cell membrane in your body is made out of them. Your brain is 60% made out of them. Your skin, your hair, your nails, all your body functions. It regulates inflammation, prostaglandins.

I mean, it's just really, really important. So it regulates metabolism, blood sugar. So it's really critical to have the right one. The next one that I think, in addition to malty and fish oil, is vitamin D. 80% of us are deficient or insufficient in vitamin D. It's so important. And COVID has kind of highlighted the consequences of this, because when you look at the data around COVID, if you're low in vitamin D, you're 70% more likely to end up in the hospital, on the ICU and die. If your vitamin D level is higher, it's actually you're 97% protected from ending up in the hospital or dying.

And if your vitamin D level is over 50, which is where I like to see it, nanograms per deciliter, there was zero deaths, zero deaths, which is better than any vaccine out there. I think so. And people are sort of ignoring that for the most part. But the data is very clear. So multi-official vitamin D. And then if I had to add a couple others around the margins, it would be magnesium or really magnesium-rich foods. And then maybe a probiotic because our guts are also messed up.

So that's sort of the stack that I like to sit on with everything else. And with the D, how important do you think it is, the K2, and you always hear that conversation? Yeah, so you need vitamin D3, which is different than a lot of doctors prescribe. And vitamin K2 is also a fat-soluble vitamin. It should be made by your gut bacteria. It's often not because our guts are messed up,

but it works in conjunction with vitamin D and helps with the improvement in cardiovascular health, bone health. And it's actually also an important supplement. So I often prescribe them combined. Okay, Mark. So that's the foundational area of supplementation. Let's get into the next one, which are these targeted supplements that are out there.

Again, built on top of incredible lifestyle, foundational diet, sleep, movement, all the things you shared, community. Get into some of the really interesting ones that are showing up now in the longevity space, the bonus supplements. Yeah. Before we do that, I just want to address a couple of things that we didn't touch on. We talked about the general research around supplements, and I think it's confusing for people because you look at these big studies and they often don't show a result. And it doesn't mean that it's not effective or important. I don't want people to understand that because we don't rely on just studies like that because

often they're poorly designed or they don't take into account the biology of the nutrients or if I, for example, if I give vitamin E to a bunch of smoking, overweight, non-exercising, junk food eating people, it's not going to do anything, right? Right. And what's the timeline of the study? How long are they looking at that? It's complicated. Yeah. It's not going to replace a healthy diet and lifestyle. The second is, how does conventional medicine view supplements? And I think this is a really important note because many times doctors will say, oh, supplements, they just create expensive

urine. It's a waste of time. You'll get everything you need from food. And I'm like, well, gee, if that philosophy were true, then you shouldn't drink any water because it just comes out as pee, so why bother drinking any water? Your body takes in what it needs and it lets go of the rest, which is exactly what it's supposed to do. The other thing is that in that closet, and this was shocking to me, Drew, at Cleveland Clinic, which is arguably one of the best health establishments in the world, Mayo and Cleveland Clinic are like one and two. The doctors are very smart. They're very well-educated. They're up on the latest research. And I thought they'd be more conservative. And so we did a survey when I got there of, one, who was using supplements for themselves, who was recommending to their patients,

and, you know, what was the percentage. And I was just shocked. 70% of the doctors at Cleveland Clinic were recommending supplements to their patient, whether it was an OB with a multivitamin for prenatal, or whether it was a, you know an endocrine doctor for osteoporosis or whether it was a heart doctor for CoQ10 or folate or fish oil. You know, it was so prevalent. And I was shocked. So I think if you go into a conference and you ask doctors, you know, who's actually, you know, supporting patients getting supplements? And very few will rinse their hands. You say, how many of you are actually taking supplements? Most of the doctors are.

It's also funny that sometimes I come across physicians, again, well-intentioned and everything, who would be so strong to recommend a prenatal, but then are like, oh, no, the patient doesn't need to take anything if they're not pregnant or trying to have a baby or whatever. It's like, well, let's just think about that. You want a woman to be taking a prenatal vitamin. And now there's actually companies that are out there that have prenatal vitamins that are also for men because their sperm is a big part of that. We have a former employee that, you know, started a company called WeNatal. So there's like supplements for the mom,

supplements for the dad and their process of trying to conceive. But anyways, going back to the mom. So you want a mother to take a prenatal vitamin to help grow a healthy baby and a healthy baby brain and take this thing and that, but then you're not recommending anything for her afterwards. That seems kind of like a little crazy. Yeah, it's a bit crazy. So going to your question about what's happening in the space of longevity, it's fascinating. I'm really deep in that science right now. And I think the question is, what are you trying to achieve with supplements in the space of longevity? What pathways are you activating?

What are the important longevity switches in the body? And how do you regulate those? So I think aside from the foundational stuff, which has a lot to do with extending life, you mentioned the fish oil study, vitamin D. I mean, there's just so much data on this that's really impressive. But in terms of specific thinking about which product supplements are effective for longevity and aging, there's a number that really come to mind. And just to kind of back up a little bit, and I'm going to get a little geeky here if it's okay, because this is a masterclass. Please do. There are a number of things called the hallmarks of aging, which are these fundamental dysfunctions that happen as we age, if we age abnormally.

So aging should be considered a disease. It's not normal. The way we see aging in this culture is a sign of abnormal aging. And we think it's normal because it pretty much happens to everybody, which they get old, diseased, and decrepit. If you're 65 years old, it's like you're going to have three or more chronic illnesses. Just how it goes, right? But it's not inevitable. And so one of the hallmarks of aging is as a dysfunction of these nutrient sensing pathways. So we have exquisite systems in our biology that sense either abundance or scarcity. Oh, there's too much of a food. We just,

we want to start to build and grow and make stuff in our body. But if there's scarcity, it activates all these repair and healing and general mechanisms. And we need both. We need, we need both a demolition team and we need a construction team to actually continue to renew and rebuild our bodies. And a lot of these supplements that we're talking about are working on some of these key pathways. So one of them is really important. It's called NAD. NAD, you've probably heard about it. It's an important compound that's part of your cellular metabolism, helps produce energy, but it turns out it has a lot broader effects. And one of the key nutrient sensing pathways is something called sirtuins. These compounds, these pathways were discovered in 1991 by Lenny Guarte and his colleagues at MIT. And it was a real breakthrough because they were able

to stimulate this certain sirtuins in yeast models and mice models and extend life dramatically, double it, sometimes even up to a thousand years equivalent in a worm or 120 or 140 in a human, how they were doing it with some of the mice studies. So what turns out is NAD is a sirtuin activator. So when NAD levels are good, which means you have energy, it turns on the sirtuins, which then creates a whole downstream series of effects that creates longevity. So it sends out a massive DNA repair team, which is awesome because we get 100,000 hits to our DNA every minute, basically from various insults from food, from oxidation, from metabolizing food, from environmental toxins,

from all sorts of things. Second, it actually inhibits one of the key hallmarks of aging, which is inflammation. And we talked a lot about inflammation on the podcast, but it does so through a particularly important mechanism that is one of the master inflammation switches in the body, which is called NF-kappa B or nuclear factor kappa B. And essentially this is a transcription factor. Transcription factors are what tell your gene what to transcribe. So how does your DNA know what to do? Well, it's listening for messages all the time from signals from your body.

And NF-CAPB is a signaling molecule that tells your DNA to make more cytokines, to make more inflammation. So when you activate sirtuins, it shuts that off. It also increases your metabolism, increases your insulin sensitivity, which we've talked about a lot on the podcast. If you want to be healthy, you have to be insulin sensitive. So it's through a whole series of different mechanisms. NAD has multiple actions through sirtuins in addition to just powering up cellular energy. And some of the studies from David Sinclair are just mind-boggling. He uses derivatives. So NR, nicotinamide riboside, is made into NMN,

which is then made into NAD in the body. So this is a normal consequence of cellular reactions. So you can give NAD as a shot or as an IV, but if you want to take it as a pill, you have to take it as NR or NMN. And David gave NMN to these mice. Now, these old mice, now they have these mice treadmill, which I'm not a researcher, so I don't really know about it, but they had these mice treadmill that have an upper limit because no mouse has ever run more than two kilometers, like young, old, any mice, right? And so they had this mouse treadmill, it was like two kilometers, and then it would just kind of turn off. It was like overheat and it stopped. And they gave this old mice NMN and the mouse ran

three kilometers and broke the treadmill. So it's pretty amazing. And even in some studies, it regulates all sorts of stuff like hormones and fertility. In some studies, they've literally been able to reverse mouse pause. So take menopausal mice and give them NMN and they start menstruating and get fertile again. Wow. It's really trippy. So that's just one example of one compound. Another one I think that's really important is something that actually, and I think curcumin or this product I think are really important, which is regulating inflammation through, again, these very variety of effects. But there's a compound called HTB, Himalayan Tartary Buckwheat derivative, that has like

132 phytochemicals, including quercetin and rutin, which quercetin also is a longevity supplement. So it contains a lot of these things. But it also contains a compound only found in this ancient grain, which isn't really a grain, it's a flower, called Himalayan Tartary Buckwheat, which has only been recently been recultivated after thousands of years of being sort of out. And because it's in the Himalayas and it's called Tujoba. And it actually is regulating some of the inflammatory systems that are involved in senescent cells and chip cells. So as we age, some of our cells just get older and they don't really die.

They're kind of like zombie cells, but they're not just inert. They're actually creating a whole inflammatory cascade. And then they're causing other cells to become senescent zombie cells. It's like, it's terrible. So you get this kind of wave of inflammation. And so this can help to kill that. And there's something called chip cells, which are cells that are from the bone marrow, from damaged stem cells that produce white blood cell. And you get these funky white blood cells in your body that are just generating tons of inflammation. So some of these compounds really help to regulate this inflammatory senescent thing.

So one of the hallmarks of aging is cellular senescence, which means the aging of your cells. And how does that happen? These zombie cells is essentially what happens. And we can go into how they're created, but it's really fascinating how these natural plant compounds combat this. And what's also exciting, Drew, is there are so many other compounds, in addition to just three, that are super powerful, like green tea extracts, epiglottic catechins, resveratrol. You might have heard about resveratrol. Resveratrol was the thing that was first sort of discovered, which is from red wine, that helps to activate sirtuins to extend life by a third. So if you actually take resveratrol from red wine, you give it to mice, they'll live a third longer, which is equivalent to humans being 120, right?

Which is kind of cool. But then how much resveratrol did they get? They got a lot. They got the equivalent of 1,500 bottles of red. Well, they got the 1,500 bottles of red wine. So don't try this at home, okay? But what was interesting is that the resveratrol, and this was fascinating, and it's kind of wild.

These pathways, these conserved longevity pathways that are really survival pathways, when they're activated, they're so powerful that they have so many beneficial effects. So even though the mice kept eating junk food and not exercising, their metabolism got faster, their exercise capacity increased, what we call VO2 max. They reversed their diabetes and insulin resistance and high blood pressure, and even while eating crap, right? So I'm like, wow, what if you actually ate well and exercised and then use this as a booster? Amazing.

Tell us about the kinds of nutritional efficiencies we're seeing at scale in America and why they're so important. I mean, if you just look at what people are eating, we're seeing that 68% of Americans are not getting enough magnesium. And so 68% are not meeting the RDI, the recommended dietary intake. And we have to remember that that RDI was set for just sufficiency. So, you know, not having a deficiency in magnesium. So what that means is those recommendations are not set at what is optimal either for that individual person. So they're just the minimum requirement in a sense. So 68% of us are not getting enough magnesium, 40% are not getting enough zinc, 78% are not getting enough folate, maybe even 90 plus percent are not getting enough of the omega-3s in their diet. So we're seeing significant nutritional deficiencies

and that's leading to so many issues in terms of chronic disease and also just feeling awful, right? Yeah. So what's fascinating to me is, you know, when I started learning about all this, you know, I learned about nutrition in medical schools, like, okay, vitamin C prevents scurvy and vitamin D prevents rickets and vitamin A prevents, you know, blindness and B vitamins prevent this and that. And I never really understood why they were important other than preventing deficiency diseases, which is sort of why we first learned about them, was from these diseases. And then I began to understand this and began to think about, you know, what do vitamins and minerals actually

do in the body? And there's 37 billion, billion chemical reactions that happen in the body every second. 37 billion, billion. I don't even know what that is. It's like a, because a billion, because a jill, you know, I don't know what it is. It's a lot. And every single one of those chemical reactions requires helpers. And the helpers are. Co-factors. Are vitamins and minerals. Vitamins and minerals, yeah.

Right? And one of the other shocking things I learned was that our DNA, one third of our DNA codes for enzymes. So enzymes are catalysts that convert one molecule to another. So all these chemical reactions I talked about all need catalysts or enzymes. One third of our entire genetic material is coding for these enzymes. And there's variations in how they work that make one person require more or less of a different nutrient, right? So some, for example, is you need more B vitamins. If you have certain variation, you might need more folate or B12 or B6. And if you take the normal amount, the RDI, which is not the optimal amount to create health, it's the minimum amount necessary

to prevent a deficiency disease. So how much vitamin C do you need to not get scurvy? Probably 60 milligrams. How much vitamin C do you need to optimize your immune system to not get COVID? Probably 4,000 milligrams, right? And it's different for each person, like you're saying, based on our genetic makeup, right? And everything else going on in our body, not just our genetics, but what other diseases we're dealing with, how we digest and absorb our nutrients. I mean, so many things impact our nutritional needs. Yeah. It's so true. Your gut microbiome determines what's going on with your nutritional levels. And you may not be producing the vitamins in your gut, like vitamin K or biotin because you have a bad gut. So it's so

fascinating to me. And really in functional medicine, our focus is on nutrition as the first line of therapy. And it's both using food as medicine, but also understanding the role of key nutrients and playing a role in how they function. So, you know, you and I have been in this field for a long time. And, you know, it's easy to be sort of a little bit arrogant and think that, you know, the traditional doctor, well, you know, people eat food, they don't need vitamins waste of time waste of money but we get kind of humbled by seeing actually what happens when we test people and i think despite doctors saying this you know when you look at the data i think i think 72 percent of doctors recommend supplements to their patients

and 79 percent take them themselves so whatever whatever they're telling you, it's interesting. And we see studies that show, oh, vitamin D doesn't affect heart disease or cancer, and omega-3 fats don't really benefit heart disease or cancer prevention. So we see these studies that are conflicting all the time. You know, I think that happens for so many reasons, right? Why those studies are conflicting. One is because we're putting everybody in that same group. So we're not personalizing the approach. And so it depends on people's health status, how they're digesting and absorbing, how their nutritional status in general, are they deficient to begin with? What are their genetic needs? So

that really impacts how somebody shifts or improves from when we give them those nutrients. So I think that one of the biggest issues with research is we're not looking at individual variations and SNPs in somebody's makeup, their genetic variations that impact what they need. And so it just sort of lumps everybody into one category. Yes. So someone, for example, had like a vitamin D receptor gene that made them require a high dose of vitamin D and you took 100,000 people and you saw them taking vitamin D.

Well, you think they're taking enough, but it might not be enough for that person. And if you actually took that subset and you studied them and you gave them the right amount to get their blood levels optimally, it might be different. It will absolutely be different. So we know with fish oil, for example, if people are eating a couple servings of good fatty fish a week, then fish oil supplements might not be as helpful for them. But when people aren't eating that, then fish oil supplements make a huge difference and help lower triglycerides and decrease risk of heart disease. So we know

that it really is dependent so much on your individual diet as well as all those other things we've spoken about. That's true. I always say, if you don't have a headache and aspirin doesn't do anything, right? If your omega-3 levels are already good and you take omega-3, it doesn't do anything, right? So I think the studies are challenging and often, like you said, it's hard to distinguish what the overall health of the patient is. And so if these patients are eating crappy diets, they're smoking, they're drinking, they're not exercising, taking a vitamin is not going to help them. They're not that powerful in that sense, right?

If you clean up everything and then you add them in, they can be extremely effective and powerful. So that's not to say that if you're overweight and unhealthy, you shouldn't take supplements because I think they will help. But they work much better if you clean up house first comprehensive a program right so um let's talk about how we learn in our practice the ultra wellness center about what people's nutritional status is how do we how do we figure that out well so we do we we look at it from multiple different angles, right? First, it starts with a physical exam.

You know, what is their waist to hip ratio? How are they holding on to weight in their body? Then we look to look for signs of nutritional deficiencies. Maybe their hair is dry or their skin is dry or they have different spots on their nails, which could indicate zinc deficiency. You know, we look at their diet intake. Wait, wait, wait. The nutritional physical exam, I just want to pause because you teach that course at

the Institute for Functional Medicine. And it's fascinating when you learn as a doctor what the clinical signs are of vitamin deficiencies, right? So we know the obvious ones that, for example, if you have scurvy, you get no gum issues, right? If you have the vitamin deficiencies, you get little cracks in your mouth called chelosis yeah if you have white spots and there's might be zinc deficiency if it's for example on the back of your arms you know or dry skin we think about vitamin a a lot we think about zinc yeah um and my favorite test is a vitamin d test you know what that one is

yes tell us about so when you're if you if you bang on somebody's leg and they have pain, then that could be a sign that they're low in vitamin D. Yeah, so if you take your thumb and you press right now, ready to go, press right now on their shin bone, and if it's tender, then it means you're probably vitamin D deficient because it makes your bones soft. Now, I take vitamin D,

so my bone doesn't hurt at all when I press on it. You're pressing right now. Yeah, mine doesn't hurt either. Yeah, you go. I'm taking my vitamin D. I'm taking my vitamin D. I'm taking my vitamin D. So you can do a simple test. So there's a lot of things clinically you can figure out that are signs of nutritional

deficiency. So that's the first thing. And I think that's really important to look and examine because biomarkers are not perfect, which are lab tests. But they can be very helpful. But they're not perfect at determining everybody's nutritional deficiencies. For example, magnesium. very helpful, but they're not perfect at determining everybody's nutritional deficiencies. For example, magnesium. We know that magnesium, as we talked about, it's a very common deficiency,

but sometimes the serum magnesium and red blood cell magnesium can be normal and somebody can still be deficient in magnesium and would benefit from more magnesium, whether it's dietary or supplement-wise. Well, that's the other thing. We take a detailed history. So by actually questionnaires, you can determine what your nutritional deficiencies are. So I wrote my book, Ultra Mind. I literally had questionnaires in there. How do you know if you're zinc deficient, vitamin E deficient, magnesium deficient, folate deficient, you know, so forth.

And you can actually do these questionnaires and you're going to get a pretty sense if you're deficient or not. And then you look at their diet too. You know, you look to see what they're eating and what they're not eating. When somebody's a vegan, you're thinking more about, okay, I've got to really look for B12. I've got to really look for issues with iron. I've got to really think about zinc and the omega-3 fats because they're more common deficiencies.

Yeah, if you're not eating any animal. Iodine because you don't eat fish, right? So there's things we have to think about depending on what their diet is like and their digestive system. So we do a comprehensive approach. And the biomarkers can be really helpful too. They're not perfect, but- Like blood tests or what other tests? So we can look at blood, we look at urine. We do this panel called the ION panel, and it's this all-over nutrition panel. It gives us so much good information. It tells us about amino acid levels.

Those are the components of protein in the blood. Building blocks of protein, yeah. Yep. And it tells us about omega levels, omega-3 levels, omega-6 levels. It tells us about mineral levels. It tells us about all those steps of the mitochondria and the steps of the Krebs cycle, which need nutrients to work properly. Like you were talking about those cofactors, the vitamins and minerals that help those reactions work. So we can take our food and turn it into ATP or energy. So when we have deficiencies in certain

nutrients, we'll see shifts in this panel called the organic acid testing, which, you know, that's really helpful. It's a urine test. It's a urine test. So that's really important. So what you're saying essentially is that we use a lot of different kinds of testing because your typical doctor will check your blood levels, but if you check your blood levels of folate or magnesium, they go, oh, it's fine. You're not necessarily fine so each nutrient requires a very different approach depending on the nutrients so vitamin d yeah you can check your blood level of vitamin d you got to check the right one but it's pretty good

yes right you can check your blood levels of omega-3s pretty good right but you want to check in the right way yes some like folate or B12 or magnesium, not so much. Not so good, right? And I think, you know, you mentioned magnesium. It's a really good point. So a lot of doctors will check magnesium. Now, if it's low on a regular blood test, it means you are in big trouble. You're really low.

You're really low. And then you can check red cell magnesium, which is a little bit better. Yep. But the true test is something called a magnesium loading test, which is what? So you give magnesium and then you collect urine for a period of time. So that magnesium, depending on the level of sufficiency that somebody has in their body, that will impact how much magnesium that spills over into their urine. It's not a test we do very often, but you really want to know. You got to give someone a load of

magnesium. If they pee it out, they're good. If they hold onto it and nothing comes out in the urine, they're pretty low. And you know, and you were mentioning folate and B12. I see this all the time. People come in with a B12 level that their doctors did and it's normal. And so then they go, okay, they, I don't need B12, but, but many times that's not really telling us about functional markers of B12 or what is sufficient for that individual person. So we'll do things like methylmalonic acid and homocysteine. They're more functional markers of the B vitamins that give us a lot more information than just a serum level of a vitamin. So in other words, is it doing what it's supposed to do in

the body? And if it's not, you're going to see a backup of these other compounds that we don't normally test. But doctors, just check your B12, folate, they're fine. You may not be fine. And I've seen many patients who are not fine and who have very severe deficiencies and often you can tell if someone needs a certain type of a nutrient. Looking at their genetics and their blood tests, you can tell they need this form or that form of the nutrient. So it becomes very sophisticated in an approach to functional medicine. I mean, I think that's a great example of where a lot of supplements out there are not great because they're not giving the right type of nutrients within the supplement. So for example, if a supplement is less expensive, they may use folic acid in the multivitamin.

And not everybody, because of their genetic makeup, can utilize folic acid and use it for what the body needs folic acid for, folate for. So folic acid is a synthetic form of folate. They may increase risk of problems. Yes, increased risk maybe of cancer, right? So not everybody can take folate and the form of folic acid and utilize it if they have a shift in this, if they have a genetic variation called the MTHFR gene and there's others as well. And so those are things we look at as well. And when we use vitamins, we use really good quality ones, ones that are more, the body's more able to utilize like a methylfolate form.

And that makes a huge difference for people. Yeah. And in so many aspects, actually picking the vitamin, right? It's not just the form of the nutrient, but is it the form that's bioavailable? Is it absorbed? What is in with it that can prevent its absorption? What exactly is it? So you can say, well, I need magnesium. I'm just going to go to the store and get some magnesium. It's usually magnesium oxide, which is really cheap magnesium it's in most supplements but doesn't really get absorbed very well and may not be effective right so that right magnesium oxide and also magnesium citrate right they're more likely to pull water into the gut and so they will they'll loosen up the stools for some people they need that and that's good

but it's not as well absorbed as like a chelated form of magnesium, like magnesium glycinate, which is much better absorbed into the body. So depending on what you're using your magnesium for, you know, you want to be making sure you're choosing the right one. Yeah. So, so what's different about here at the Ultra Wellness Center, what we do in functional medicine is that there's a really deep understanding of the role of nutrition and nutrients in health.

Yes. And, And what's so important about these is it's not that they're single function compounds, right? So, you know, if you take a drug, it usually hits one pathway, does one thing, right? When you take magnesium, it affects 300 different enzymes and has many, many other functions in the body. It's phenomenal. Magnesium is an amazing mineral and it's so good for us in the body. It's phenomenal. Magnesium is an amazing mineral, and it's so good for us in so many ways. And when people are magnesium deficient, we see all sorts of issues from depression, anxiety,

muscle cramps, hypertension, asthma, restless leg syndrome, diabetes, more insulin resistance. So magnesium is so- Don't forget constipation. Oh my goodness, I forgot constipation headaches yep right it's it's a great yeah twitchy muscles when people get twitchy eyes yeah I had a lot of twitchy eyes and met in residency I love magnesium so many help my twitchy eye so people needed for all these problems yeah get treated for constipation they

get treated for and we in this the sort of ironic thing about magnesium is that it's used all the time in medicine as a last resort, right? So when a woman comes in who's in preterm labor and their uterus is contracting like crazy, they get IV magnesium. If a woman is high blood pressure in pregnancy, they come in, they're about to have a seizure, they give them IV magnesium. Why? Because it works better than anything else. If someone's having a

cardiac arrest and arrhythmia, when all the other drugs fail, they give them IV magnesium as the last step because it helps to relax the heart muscle. So I call it the relaxation mineral. So anything that's twitchy, irritable, or tense, whether it's anxiety, insomnia, constipation, muscle cramps, twitchy blood vessels, high blood pressure, twitchy heart, which is palpitations, twitchy emotions, which is anxiety. All these things are related to insufficient magnesium. And they're treated, you know, take Xanax for anxiety. Take a laxative for constipation.

Take a migraine pill for your headache. Take this or that for this or that. And it's unfortunate because this is such a simple solution. And we know it's a vicious cycle, right? We know that chronic stress, when we're under chronic stress, that that causes our body to excrete more magnesium in the urine. So we become more deficient in magnesium. Chronic stress? Who's got that? I know, right? So then you become more deficient in magnesium. We're living in a very stressless time right now. And then you get more anxious and then you use up more of your magnesium so we know that

when we're we're dealing with chronic stress we're using up our magnesium we're excreting more magnesium and we need even more magnesium because that was what helps us feel calm and so so it's it's we'll go through all the things that actually cause us to lose magnesium. So, I mean, we... Stress. Stress, a big one. It's huge. I remember, if I just interrupt, I remember one study I read of Kosovo, and they did magnesium

studies, and they found that people in Kosovo, under all that war and stress, they had really huge amounts of excretion of magnesium, whereas people who weren't in that environment didn't. Yeah. Right? We know that people who take like proton pump inhibitors- Acid blockers. Acid blockers, yeah. I mean, like Protonix and Prilosec and Nexium and all those drugs.

Yeah, that decreases your magnesium absorption. So just depending on your medication, that can deplete your body of magnesium. Diuretics. Yep. Blood pressure pills, which you need magnesium to control your blood pressure. You're taking a pill that caused you to lose magnesium. Right. Again, that vicious cycle that we see all the time. Yeah. Alcohol. Alcohol depletes your body of magnesium and all the B vitamins. So I think that's important. Smoking. Well, nobody's into smoking. Sugar.

Yeah. And my favorite of all of them, coffee. Yeah. Right? Coffee causes magnesium loss. So you live an American lifestyle where you're drinking coffee, drinking alcohol, lots of stress. You have, you know, probably a pretty crappy diet. And then you take a proton pump inhibitor. You take an acid blocker.

You take an acid blocker if you're eating a crappy diet. And then on top of that, you're eating a very low magnesium diet. So talk about how that plays a role. You know, magnesium is in so many of our foods. Magnesium's in our... Well, not the foods we actually eat. Well, yeah, but it's in our nuts and seeds, our beans and legumes, our vegetables. Greens.

Greens, yep, our vegetables. And it's in whole grains like quinoa and buckwheat. So it's in a lot of our food. But when you take, for example, brown rice and you make it white rice, you deplete, about 90 plus percent of the magnesium is released or is lost in that processing. And they don't spray that back on. They'll spray back on some B vitamins, but not the magnesium. So when people are eating refined and processed foods, they're getting a more magnesium deficient diet. So even sometimes people don't even realize they're getting refined and processed foods. I mean, sometimes people are like, I have a healthy

diet, but they, they forget about that piece of toast at breakfast or the crackers at lunch that are made up of have white flour in them and that are, are more magnesium deficient. So, um, and as we get older, we can't really eat as many calories as we used to, so we're more likely to have problems over time as well. I think the diet is so magnesium deficient. Our lifestyle is so magnesium depleting. And so we're kind of getting it from both ends. Yes. And we see this as one of the most common problems in our practice that is undiagnosed, and the patients think we're geniuses

because all these problems they've suffered from just go away, and they're like, wow, how did you know? Well, it's not that hard. It's just good medicine, and we know. I mean, this is not functional medicine. It's just medicine, and it's often being missed. Most of us are sick, and what ends up happening is you, you look, you basically, you know, don't, you're not able to absorb nutrients. Well, if you have a damaged

gastrointestinal tract for one. And so, so many people are suffering from gluten intolerance, celiac disease, Crohn's, ulcerative colitis. And if you have damage to the gastrointestinal tract, which many of us do from eating these processed foods, you can't even absorb the minerals. And then even if you are able to absorb them, we require insulin to drive numerous minerals into the cell, including magnesium and potassium. And we know 75% of the US population is insulin resistant and has high levels. So you can't even get it the minerals into the cell as well when you're insulin resistant. And if you have elevations in your insulin levels that kicks out magnesium and calcium in the urine as well. And so wait, wait, wait, just so we unpack this,

you basically eat a lot of sugar and starch or insulin goes up, and you start to pee out minerals, like magnesium. Yeah, you can drive them into the cell to utilize them. So you could be taking, you know, all the magnesium or calcium or potassium that you would like to take in a day. But if you don't fix the insulin resistance, you're never going to get the full driving of those nutrients into the cell where it actually is needed to work. Amazing. So, and then the other thing, you know, so you have chronic diseases, which then cause your minerals to become depleted. You have, you know, soils, which are not good, which allows us to sort of not get the minerals. We have processed food, which, you know, just by nature has no minerals.

And then we take medications, which often are mineral depleting. And, you know, in medical school, we all learn, oh, yeah, if you give someone a diuretic for high blood pressure or for heart failure, you have to give them potassium because the medication causes potassium to leach out in the urine, but also causes other minerals like magnesium. So talk about this general idea.

We talk about, oh, be careful of taking those supplements that can interfere with your medications. But the opposite is also true, that whatever medications you're taking may be causing massive nutritional deficiencies, whether it's an acid blocker causing B12 deficiency or certain antidepressants things causing B6 deficiency or the diuretics causing magnesium deficiency. So talk about the minerals and the depletion of our nutritional status by the medications. What are the top medications that cause the problems and what do they do? Well, one of the first medications a doctor will throw someone on if they have high blood pressure is something called a thiazide

diuretic. So something like hydrochlorothiazide or chlorthalidone, indapamide are some of the names that some people may be familiar with. And you're right that the medical community thought for a long time, and they still think this, that the potassium depletion, you just give these people more potassium, but it's really the magnesium depletion that these thiazide diuretics are causing that is causing the body to not be able to hold onto potassium. So 80% of people who are on a thiazide diuretic for six months or longer are deficient in magnesium, 80%. And it's one of the most prescribed medications in the United States.

What's so fascinating about that is that magnesium lowers blood pressure. So you're kind of getting rid of the very mineral that you need to keep your blood vessels relaxed and not have high blood pressure. In fact, that's what we give women when relaxed and not have high blood pressure. In fact, that's what we give women when they come in with high blood pressure from pregnancy, we call it preeclampsia. The treatment is intravenous magnesium. Right, exactly. We used to, before we had all these types of medications, we used to treat many health conditions with magnesium, including preeclampsia. There have been many clinical studies that show that live birth rates are much better, especially if you start earlier on in your labor or preterm with magnesium

supplementation. And so it really is the missing, one of the missing minerals in the diet. And it's said that 50% of people with high blood pressure or heart disease have magnesium deficiency and half the population isn't even getting the RDA for magnesium. And what's interesting, what we talk about in the mineral fix. So before you go into that, so the RDA for listening is minimum amount you need, or they call them RDIs, the minimum amount you need to prevent deficiency diseases. It's not how much you need for optimal health. It's like how much you need to get scurvy for vitamin C or rickets, you know, vitamin D. It's not really the amount your body needs for optimal functioning. And so it's so important to rethink our approach to nutrition based on optimal performance and

function rather than simply prevention of deficiency diseases, which is what our whole medical training has been around vitamins. And the interaction between the drugs and the nutrients is a really big deal. And like you're saying with thiazide diuretics, but there's other examples of other nutrients that get depleted. What are a few other examples of common medications and the nutrients that they deplete? Well, another common medication is proton pump inhibitors, which are prescription, quote unquote, acid suppressing therapies, as well as antacids over the counter. There's actually a third leading class of drugs, by the way, after statins and antidepressants, it's the third leading class of drugs.

Exactly. And if you have heartburn or reflux, most doctors will just throw these at you. And you're not really supposed to be on them for longer than two to three months at the most. Doctors used to just kind of put people on these for years and they started noticing that people were becoming deficient in numerous minerals, particularly magnesium. And now there's an actual black box warning that these medications can lead to magnesium deficiency, an actual black box warning. A black box warning is on the label. The pharmacist has to put this black box that says, if you take this medication, this is going to happen to you, or this may happen to you, you might get magnesium deficient. So this is kind of a big deal for that to happen. Right, exactly. And well, that's the crux of the book. The mineral fix is that the RDA does not match the optimal intake for nutrients. And most people understand that things like refined sugar, zinc carbohydrate, and refined carbs and seed oils are bad for their health. But what a lot of people do not realize is that if you do not hit optimal intakes for nutrients, that is just as damaging to your body.

Well, that's a, that's a big sentence. So, you know, if you are avoiding all the crap and you still don't have optimal levels of nutrients in your body, it's still harmful to you. It's extremely, I mean, they, what was really interesting was one study. They put women on a diet that contained a hundred milligrams of magnesium within just a few weeks, a third of those women developed atrial fibrillation and atrial flutter. So you can induce arrhythmia simply by lowering the magnesium content of the diet. And you can see these types of harms with numerous nutrients. They've done this, this with copper as diet. And you can see these types of harms with numerous nutrients. They've done this with copper as well. If you go on, this is actually what's really scary.

We have the RDA completely wrong for copper. So it was set based on essentially just one or two balance studies, and they forgot to actually test mineral losses through sweat. They didn't think copper was lost through sweat. So they just looked at urine and stool copper loss for the RDA for copper. Well, it turns out that we lose about 0.3 milligrams of copper through sweat per day. And so the RDA doesn't even actually maintain balance for likely half of the population. And there are studies that show that if you even go slightly above the RDA, if you put someone on, let's say one milligram of copper per day, you can induce insulin resistance, high cholesterol, high triglycerides, all these problems that you would induce with a high sugar diet simply by eating a low amount of copper. Wow. That's incredible. So we've got copper, magnesium. What are the

other common minerals that were low in and what are the impacts of those? The top 10 minerals are really boron, manganese, potassium, magnesium, calcium, zinc, selenium, even molybdenum. And when it comes to immune health, we all know that zinc and selenium are extremely important. And simply being deficient in selenium can essentially turn non-virulent viruses into something that could potentially kill you. Well, you know, there's a fascinating study on COVID in China, where they look at areas where there was high selenium in the soil versus low selenium, where people were tending to be deficient in selenium. I think they had five times higher risk of getting up in the hospital or dying or three times higher risk. It was a dramatic difference between the adequate and the

deficient selenium groups and so just that's just one mineral but we have many many minerals that are all dynamically interacting together that regulate thousands of different biological functions and these people think oh what vitamins minerals are just you know not really that important or you can get it all from your food or um you know we're not really that deficient how can we be deficient we're such a well-nourished country. There's so much obesity, but there's actually a phenomenon of the more obese you are, the more mineral, nutrient, vitamin deficient you typically are. Even like vitamin D, it's sort of striking to see this paradox of sort of obesity and malnutrition going together. And we really have this moment to sort of look at our biology, go, wait a minute,

how do we optimize it? Because it's not simply about, you know, getting adequate levels, it's about getting optimal levels. And that has a profound effect on our overall biology. So tell us a little bit more about, you know, why these deficiencies drive disease. You mentioned a little bit about it, but I think, give us some practical examples of if I'm deficient X or Y, what will I see as a doctor in my practice? Well, if you think about, let's say, just let's talk about brain health, for example. If you want to actually create the three feel-good neurotransmitters, serotonin, noradrenaline, norepinephrine in the brain and dopamine. There's enzymes in the brain that require minerals to actually create serotonin and then also form melatonin from serotonin. They

depend on like magnesium, zinc, calcium, iron, copper. If you are deficient in those minerals, most doctors don't even look or test for that. they simply just give you an antidepressant or if you can't sleep they will simply give you a pill to help you sleep but if you're deficient any of those minerals the enzymes can't even convert tryptophan eventually to serotonin and melatonin so a lot of these issues with sleep anxiety mood disorders depression are literally being driven by these mineral deficiencies yeah it, it's incredible. I mean, I've seen so much. I just read this one patient might've done before, but she had no classic signs of magnesium deficiency.

She was a doctor radiation oncology resident, actually worked at Mayo clinic and seen the top headache specialists had intractable migraines was on narcotics and Zofran, which is like a chemo anti-nausea drug. And so I talked to her and I said, well, tell me about your other symptoms besides the migraines. I said, how's your digestion? So, you know, I'm pretty regular. I'm like, oh, well, well, how often do you go to the bathroom? She's like, I'll go once a week. I'm like, that's not regular. She goes, regular for me, I go every week. I'm like, no, you got to go every day. I said, well,

tell me other symptoms you have. Well, I have anxiety. I have insomnia. I have palpitations. I have muscle cramps. I have bad menstrual cramps. These are all signs of magnesium deficiency. And if you're alert to it, and it may be other things like sensitive to loud noises or irritability or, and anything that sort of spasms twitchy or irritable is typically a sign of magnesium deficiency. And that's because magnesium is a relaxation mineral. And, and when I gave her magnesium, I literally had to give her 2000 or more milligrams a day in order to get her to start going to the bathroom and relieve her headaches. And it was amazing. Once we gave her the magnesium, all of her symptoms went away. And, and, you know, what causes magnesium deficiency besides not getting your diet is

things like caffeine and stress. You know, I remember one study in Kosovo where they looked at magnesium levels in the urine and they found high levels in people who are really stressed and you can't really test for it in a way that most doctors test for. It's not really adequate. So maybe, would you mind just sharing a little bit about the challenge we have with testing and how we can diagnose these mineral deficiencies? Because people are like, I'm listening to this and I'm like, do I have mineral deficiencies? Is it causing my health issues? How do you diagnose it? Because typically traditional medicine is pretty crappy at diagnosing nutritional deficiencies and particularly around minerals. Right. That's a good question. And part of the problem is, is some of these minerals are what

are called acute phase reactants. Meaning if you have inflammation in the body, the levels of those minerals will either go up or down depending on inflammation. So for example, if you are inflamed, zinc will go down, selenium will go down, and iron will go down. And you may not be deficient, but the inflammation is driving it down. On the flip side, inflammation will actually increase copper levels. So you could be deficient in copper, but the inflammation is driving your levels up because it's an acute phase reactant. The other problem is most minerals do not sit in the blood. They're mostly in the tissue or the bone. So take magnesium, for example, 1% of your entire body's magnesium is actually in blood. 99% is in things like muscle and bone. And of course, we're not going in and, you know, taking a sample of someone's bone or tissue to test for magnesium deficiency. So what are some of the best ways to actually look for mineral deficiencies that people can actually do? And it's really actually looking to see if you're at the lower end of normal on a blood test. So what happens with mineral deficiencies, you don't typically fall

below the actual normal threshold unless you are significantly deficient. But what will happen is you will go from a middle point of normal just to the lower end of normal. And if you're sitting on that lower end of normal, especially if you have a low amount coming out in the urine, that is highly indicative of mineral deficiency. Yeah, that's a great point. I think, you know, we in medicine, we're learning lab tests and we see, okay, this is the normal range, you know, but when you understand what normal means, it's a statistical number based on the population. So if I were to land in America from Mars and I go, Hmm, what's the normal weight of Americans? Well, given that 75% are overweight, it's normal to be overweight. It doesn't mean it's optimal.

And in addition, we use this sort of two standard deviations, meaning we use a wide bell curve for figuring out what's normal. So you can be two or 92 and it's still the same reference range, right? And maybe it should be like one standard deviation should be where we're thinking is optimal. And anything outside above or below is a problem. And I think we're learning this in medicine, that disease is not just an on or off phenomenon. It's a continuum. So you might, for example, see blood sugar being normal up to 100. But in fact, we know that if your blood sugar is over 87, according to Israeli studies,

that your risk goes up of heart disease and death in a linear way. So 88 is worse than 87 and 90 is worse than 88. And the same thing with nutrition. I mean, we, we, we don't want too much, but we don't, we don't want to make sure we have optimal levels. And you know, magnesium is interesting phenomenon. When I, you know, started practicing magnesium is one of those miracle drugs that i was started using in functional medicine it's like incredible it helped people sleep with with all sorts of issues and uh it's hard to test because the typical thing i learned in medical school was just check the serum magnesium level so you're thinking it's a low end abnormal which is like two then you're worried you're worried but by the time he gets there you're already pretty depleted um and then you can look at red cell levels which is like two, then you're worried. But by the time he gets there, you're already pretty

depleted. And then you can look at red cell levels, which is a little bit better, which is what's in the cells, because typically magnesium is more in the cells. But that also isn't perfect, although it can be a little bit better. And then there's the real test, which is a magnesium loading test, where you basically deplete the body of magnesium. You don't take it for a while. You give a big magnesium load, and then you collect the urine for 24 hours because that'll tell you how much spills out. If you hold all the urine, if you hold all the magnesium in your body, it means you're pretty deficient if you don't pee it out. And yet nobody does that test. There are other indirect tests we use like organic acid testing and so forth. Amino acids, we can sort of indirectly tell whether there's some nutritional deficiencies but it's really tough so besides magnesium um what are the other tests if you're

if you're uh you know wanting to know what your nutritional status you just go to a regular doctor and get regular tests or what are the best tests for the top things like selenium zinc magnesium we talked about uh copper yeah so the best best test that has actually been matched against the gold standard IV magnesium load is actually mononuclear blood cell magnesium levels so white cell level yeah it's called mononuclear blood cell and it's the only blood test that I've ever seen that actually correlates well with the IV magnesium load, which is the gold standard for testing for magnesium deficiency. So that typically though is not ordered by your doctor.

And that's the problem, right? Is that you would think the first thing that all of us would know is we would have a list of 20, 30, 40 vitamins and minerals, and we would understand if we're deficient or not. And our doctor would first instantly say, okay, you're deficient in 10 minerals. Here's the foods you need to start eating to replace those. They don't do that. They just say high cholesterol, high blood sugar, high blood pressure. Here's this pill, this pill, and this pill, and they send you on your way. And that's the problem. We need to get health insurance companies to pay for and reimburse for vitamin mineral tests because you can do hair analysis. It's not perfect, but that is a three

month reflection of blood. So that's a potentially better way for numerous minerals. You always want to have serum as well, and you want the serum to be not on the lower end of normal. And then you can also do many other tests, but typically it's white blood cells that you look at for minerals, whether it be perfills or leukocytes, leukocyte, copper, neutrophil, zinc are some of the best tests to actually get for those minerals. And people can do that through the regular lab test. Typically. I mean, typically doctors don't do that. There's certain companies that specialize in those types of tests. And some have their own unique methods for doing

this. But that's the problem. We don't have insurance companies demanding or paying for these better tests or minerals. So most people are stuck with serum. And they just you just want to make sure that you're definitely not at the lower end of normal on serum. Yeah. Great. Okay. So we were seeing that there's massive deficiencies. We probably need to take something. How, how do these nutritional deficiencies of micronutrients have on our health span and lifespan and in terms of longevity and premature aging? And how do we, you know, how do we get to avoid premature aging and increase our longevity? So what we sort of need to understand is everybody

focuses on macronutrients, right? How much carbohydrates versus how much fats, you know, people that are high carb, people that are low carb, they forget that it's the minerals that determine how well you actually convert those macronutrients into energy, uh, how well you, your muscle can grow, how much ATP you can produce. Everything is dependent on. Uh, so I, I, I kind of laugh when people say it's all about calories with weight loss, when literally your fat burning machinery depends on minerals. So some people can be eating a low calorie diet, but a nutrient micronutrient deficient diet, you're going to gain much more weight than someone who is eating more calories, but are getting more minerals because your fat burning machinery will actually

work better. So take magnesium, for example. You cannot activate ATP without magnesium. It binds to ATP, it cleaves the terminal phosphate, and it releases energy, everything depends on ATP, magnesium is required to produce protein, DNA, RNA, I don't know a single function in the body that does not work without ATP and protein and DNA. So literally, everything depends on minerals. And so, like you had said, I mean, magnesium is the relax mineral. It prevents calcium from actually accumulating in the arteries. So one sign of mineral deficiency is coronary artery calcification, which a lot of docs are starting to use versus just cholesterol tests. Yeah. So how does mineral deficiency cause the calcium deposit? So essentially, magnesium is nature's calcium channel blocker, and it prevents the cells,

the endothelial cells that are lining the arteries from accumulating calcium. And so there is this balance we talk about in the book that it's not also just about the overall amount of minerals you're getting. It's the balance between them. You have to want to have really more than a two to three to one ratio of calcium to magnesium. Otherwise, you're going to start getting issues because the balance is off. I hope you enjoyed today's episode.

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